Study: Americans are Delaying Cancer Screenings, Believe Racism Affects Health Care

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Almost 60% of Americans believe that racism can impact the health care an individual receives, according to the National Cancer Opinion Survey conducted by the American Society of Clinical Oncology (ASCO).

The survey also found that about two-thirds of Americans have skipped or delayed scheduled cancer screenings due to the COVID-19 pandemic, which is disproportionately harming Latinos.

These results have wide-ranging implications for preventative care and the perception of health care disparities in the United States.

About the Survey on Racism, Health Care

The National Cancer Opinion Survey is conducted annually. This year, ASCO surveyed over 4,000 U.S. adults older than 18, with over 1,000 of them former or current cancer patients.

“This survey assesses Americans’ perceptions of a wide range of cancer prevention and care issues during a most turbulent time in our country. We set out to capture Americans’ views during a time of both a devastating pandemic and a national movement for racial justice. Our goal is to better understand public perceptions and address urgent needs and opportunities,” said Lori Pierce, ASCO President, according to ASCO’s website.

The survey had relevant findings about people’s perceptions of racial disparities in health care:

• Latino (22%) and Black people (27%) are more likely than white people (16%) to believe that race impacts someone’s chances of surviving cancer.
• 70% of Latinos believe that racism can impact the health care a person receives.

The survey also had findings related to the impact of COVID-19 on cancer screenings and mental health:

• 64% of people scheduled for a cancer screening test (mammograms, colonoscopies, skin checks, HPV tests, etc.) during to the pandemic reported that their tests were delayed or cancelled.
• 63% of people were concerned about being behind on cancer screening.
• Almost 50% of cancer patients say that the COVID-19 pandemic has had a negative impact on their mental health.

Another finding from the survey indicates that many Americans misunderstand the efficacy of cancer clinical trials, despite their willingness to participate in them:

• Almost half of the survey respondents think that clinical trials are not the best possible way to treat cancer, when actually a clinical trial can provide more advanced treatments than the standard.
• About 75% of Americans believe some cancer clinical trial participants receive placebo treatments, while in actuality they are extremely rare.

Concern about Preventative Care

The survey showed some concerning results regarding preventative care.

“While delaying recommended screenings for a few months is not necessarily dangerous, our biggest concern is that a significant number of Americans might stop getting preventive care for long periods of time or altogether,” said ASCO Chief Medical Officer Richard L. Schilsky, according to the ASCO website. “Cancer screenings are critical for detecting cancer early, and early detection is key to successfully treating many cancers. We need to make sure people continue to get their routine, evidence-based cancer screenings within a reasonable time period.”

Preventative care can be life-changing. It might mean catching cancerous cells before they spread, potentially extending someone’s lifetime.

But as the COVID-19 pandemic persists and cancer screenings are pushed back further and further, people may put off preventative care for far too long or even indefinitely.

COVID-19 isn’t the only factor delaying preventative care. Many factors, such as insurance and lack of access to medical facilities, prevents people from seeking preventative care.

Latinos living in rural areas have some of lowest rates (30%) for obtaining flu vaccinations, according to a study done by the University of Minnesota Rural Health Research Center. This study also found that rural Latino residents also had the lowest rates of cancer screenings.

“Low rates of preventive care among rural Hispanic residents may derive from multiple factors, including financial access barriers such as comparatively lower rates of health insurance coverage and higher rates of health insurance churn,” according to the University of Minnesota Rural Health Research Center.

Studies point to immigration status, eligibility for publicly-funded programs, and lack of insurance as potential barriers.

“Being uninsured was a barrier to receipt of preventive care for Puerto Rican women, while being poor was a barrier to the receipt of preventive care for all Latinas,” according to researchers Llewellyn Cornelius, Pamela Smith, and Gaynell Simpson.

Implicit Bias in Healthcare

In addition to the results about delaying cancer screenings, the National Cancer Opinion Survey found that most Americans believe racism can play a role in determining the quality of your health care.

Unfortunately, implicit bias has led to many disparities in how doctors treat people of color.

Due to implicit bias, many incorrect assumptions and adverse health outcomes persist, such as:

• Latino men are less likely to receive treatment for high-risk prostate cancer than white men. Uninsured non-Latino white men were 37% less likely to receive definitive treatment than those with insurance, and uninsured Latinos were 66% less likely to undergo definitive treatment compared to their insured counterparts.
• Latinas and other pregnant women of color face discrimination from healthcare providers. This is due not only due to their race, but their socioeconomic background as well.
• White male doctors are less likely to prescribe pain medications to black patients than white patients.
• Latino and Black patients are less likely than white patients to receive prescriptions for certain medications in an emergency room.

“Fortunately, implicit biases are malleable,” according to a Salud America! research review. “This means these unconscious associations can be ‘unlearned’ and replaced with new mental associations.”

What can you do?

Implicit bias is a persistent issue in health care. So is the lack of access to preventative care.

These issues have severe consequences for Latinos and other people of color.

Fortunately, we can take steps to overcome biases.

To start, take a quick test to see if you have any implicit biases.

Seek training or help put an end to microaggressions. In the healthcare field, teach cultural competencies and cultivate more doctors of color to help produce better outcomes for Latino patients.

Researchers Cornelius, Smith, and Simpson recommend these policies to help Latinos and other people of color obtain preventative care:

1. Target physicians through graduate medical education programs showing the importance of health prevention activities during office visits.
2. Address differences in coverage for preventive exams by insurance status (private and public insurance).
3. Prioritize the time spent during office visits for preventive care relative to other activities to assess costs and benefits.
4. Increase health insurance coverage for more people of color.
5. Examine the rate of underinsurance for preventive health care.
6. Infuse funding to increase the supply of health care providers in inner-city and rural communities through mechanisms such as section 330 of the US Public Health Act (community health centers), and assure funding to the Health Research and Services Administration to increase the number of providers in medically underserved areas.
7. Increase funding for community-based health promotion projects and community involvement in local health decision making activities.
8. Provide funding for dietary outreach efforts in communities.

“Racism undermines public health, and it specifically affects patients with cancer,” said Dr. Pierce, ASCO President, according to the ASCO website. “Now is the time to address the systemic issues of health inequity that negatively impact the health of Blacks and other people of color in our country.”